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A medical emergency can arise suddenly, out of nowhere, affecting both individuals and families alike. And with rising medical inflation being a common cause of worry in India, it has led to healthcare services becoming very costly, ultimately standing as an obstruction in the way of timely treatment.
Here is where a Mediclaim Policy swiftly steps into the picture, being an essential financial shield to ensure you can receive the best possible medical treatments—without the worry of it eating into your savings. The expenses caused by any illness, injury or accident that results in hospitalisation are covered by a Mediclaim policy in India, thereby helping ease the financial burden brought about during these tough times.
A Mediclaim Insurance Policy is mainly focused on covering hospitalisation expenses incurred due to any sudden illness, injury or accident which requires quick medical attention. This can include coverage for inpatient hospitalisation expenses, such as OT expenses, doctors’ fees, nursing charges, medicine costs, room rent, ICU charges, etc.
Unlike regular health insurance, a Mediclaim Policy is mainly focused on covering hospitalisation expenses, which may lead to more affordable premiums but also a fixed sum insured for each claim. Certain health insurance plans also pay a lump sum amount on the diagnosis of any covered critical disease, irrespective of your medical expenditure.
If you are still on the fence about whether you should buy a Mediclaim Policy or not, check out the many advantages of doing so:
You are spared from the hassle of upfront payments, as many policies offer network hospitals with cashless hospitalisation benefits to settle your bills directly with the provider, helping streamline the process in medical emergencies.
As we already know, a medical emergency can strike at any point in time, which is why a Mediclaim policy plays a crucial part in easing any financial burden on you during this stage and takes care of your medical expenses seamlessly.
Under Section 80D of the Income Tax Act, it states that the premium paid for your Mediclaim policy is subject to tax benefits to help make healthcare more affordable. Policyholders can claim up to ₹25,000 for premiums paid for themselves, spouses, and children, and an additional deduction of ₹25,000 or ₹50,000 (if parents are senior citizens) is also made available.
Many Mediclaim policies offer a vast network of hospitals that help you avail cashless services. In this way, your insurer is able to directly settle the bills with the hospital and save you from upfront payments while providing access to quality and timely healthcare facilities.
Many of these plans may include daycare procedures, which include surgery or treatments like cataract surgery, chemotherapy, etc., which require less than 24 hours of treatment and allow you to leave the hospital without the need for an overnight stay.
There are not simply one or two but a variety of Mediclaim policies that one can think of availing of, based on your unique needs. Take a look at what these are:
Under this policy, only one person is eligible to receive the benefits of health insurance.
Through this plan, multiple family members, like parents, spouses, children, parents-in-law, and grandparents, are covered under a single insured sum.
This policy is specifically catered to cover the expenses incurred due to women-related illnesses, including breast cancer, cervical cancer, gynaecological issues or more.
This plan becomes crucial for elderly individuals aged 60 years and above, who are dealing with a rising number of health issues due to age.
Upon diagnosis of any critical illness like cancer, kidney failure, heart disease, etc., this type of plan provides a lump sum amount to policyholders to deal with hospitalisation expenses incurred due to it.
These plans come with a waiting period, which is why individuals planning to start a family should avail of them in advance, helping cover pregnancy-related hospitalisation costs like delivery (normal or caesarean), pre- and postnatal care, etc.
This is a policy that applies to a group of people, such as employees of a particular organisation, giving them the benefit of comprehensive medical coverage at a lower cost than individual policies.
Top-up plans provide extra cover when a single claim exceeds a set deductible, while super top-up plans cover you after your total medical expenses in a year cross the deductible, no matter how many claims you make.
When the policyholder is diagnosed with COVID-19 and required to be hospitalised, this plan helps deal with the expenses that arise along with it.
This plan helps cover any unforeseen medical emergencies occurring during your travels abroad, like accidental injuries, illnesses, etc.
Covers costs related to the hospital, like the operating theatre, diagnostics, medicines, blood, oxygen, chemotherapy, radiotherapy, donor expenses, pacemakers, etc.
Covers charges for staying in a regular ward (single or twin sharing).
Fees for doctors, surgeons, nurses and anaesthetists during hospitalisation are covered under this policy.
In case the policyholder is required to stay in the Intensive Care Unit (ICU), these charges are also covered.
Expenses for emergency ambulance transportation may also be included in this plan.
It covers the cost of prescribed medicines and medical reports that may be required during hospitalisation.
Any coverage for pre-existing diseases is excluded until the waiting period is completed.
Any kind of cosmetic procedures that include plastic surgery, cosmetic treatment, and implants may not be covered under this policy.
Any expenses arising out of dental surgeries, unless they require hospitalisation, will not be covered.
Injuries arising from the usage of alcohol or drugs will not be covered, while also including self-inflicted injuries, like a suicide attempt.
Outpatient Department (OPD) expenses, which include medical expenses that do not require hospitalisation, like diagnostic tests (blood tests, X-rays, MRI scans), physiotherapy sessions, etc., may not be covered.
Any tests or treatments related to infertility or in vitro fertilisation are not included in this policy.
Any congenital diseases, which are diseases or disabilities arising due to birth defects, are not included.
Disclaimer: Coverage details may vary between policies and insurers. It is strongly advised to carefully read and understand the specific terms, conditions, inclusions, and exclusions stated in your health insurance policy document before purchasing.
Curious to know the difference between your regular health insurance and Mediclaim Policies? Then check out the detailed table below to help you understand better:
| Parameter | Mediclaim Policy | Health Insurance |
|---|---|---|
| Coverage | Only pays for actual expenses during hospitalisation or for accidents, up to the plan limit. | Covers hospitalisation plus extra health expenses like day care, pre- and post-hospital treatments, and OPD. |
| Premium | Has lower premiums because the coverage is basic and limited. | Premiums are higher because the policy offers wider and more flexible coverage. |
| Add-On Options | Does not offer extra add-on covers. | Offers many add-ons, such as maternity, critical illness, or worldwide cover. |
| Critical Illness | Does not cover critical illnesses. | Most plans include or let you add critical illness coverage. |
| Sum Insured | The maximum insured amount is usually lower and cannot be increased beyond a fixed limit. | Policies offer higher and adjustable sum insured options. |
| Claims | You need to get hospitalised and submit bills for reimbursement or a cashless claim at network hospitals. | Allows for cashless claims as well as reimbursements for a wide range of medical services. |
| Flexibility | Plans are fixed with little room for customisation. | Offers the ability to customise coverage as per your needs. |
While choosing the Mediclaim Policy of your choice, these factors have to be kept in mind:
Based on the type of mediclaim policy you choose, whether individual or family floater, it helps impact the cost, as a family floater plan may generally be more affordable than individual plans and cover multiple members under a single sum insured.
This stands for the maximum amount your mediclaim policy will pay, and this needs to be selected carefully, taking into account factors like inflation and healthcare costs. It is important to remember that the higher the sum insured, the higher the premiums.
This stands for the age limit at which you are eligible to buy the mediclaim policy of your choice. Since every policy has one, it is vital to check beforehand to make sure that you or your family members can buy it.
Make sure to look for mediclaim policies that cover more than just hospital stays, as the broader the coverage, the more benefits you will be able to receive. Look for policies that include ambulance charges and costs before and after hospitalisation, like tests and follow-ups.
When it comes to pre-existing illnesses for insurance companies, they may generally have a waiting period of 3 years before you can receive the benefits of the mediclaim policy, so make sure to look for policies with a shorter waiting period.
For certain mediclaim policies, there may be limits, like a cap on room rent, and then the insurer won't be willing to pay beyond this limit. So, it is necessary to check and understand if there are any sub-limits included.
Before buying a mediclaim policy, it is essential to know what co-payment means, as this could involve you paying a part of the claim amount yourself, like 10% or 30%, and the insurer pays the rest.
It is necessary to know and read clearly what is not covered in your mediclaim policy beforehand, with the common exclusions being treatments for addictions, cosmetic surgeries, outpatient expenses, and infertility treatments.
Always pick an insurer with a high Claim Settlement Ratio (CSR), preferably 80% and above, because this refers to the percentage of claims settled to the total claims received in a year by the insurer.
If you are looking to get your hands on the ideal Mediclaim Policy, have a look at these top insurance providers and the benefits they can provide you:
| Mediclaim Policy | Sum Insured & Claim Settlement Ratio | Unique Benefits |
|---|---|---|
| Aditya Birla Mediclaim Policy | 2 lakh – 2 crore | 92.97% | Offers wellness programmes and covers critical illnesses with a vast hospital network for cashless service. |
| Bajaj Allianz Mediclaim Policy | 1.5 lakh – 1 crore | 93.68% | Provides fast claim settlements, a large network of hospitals, and comprehensive coverage for hospitalisation. |
| Care Mediclaim Policy | 1 lakh – 6 crore | 92.77% | Includes wellness incentives, high sum insured options, and quick claims processing with cashless treatment. |
| Digit Mediclaim Policy | 2 lakh – 3 crore | 96.71% | Features a fully digital claims process with 24/7 support and customisable add-ons. |
| Future Generali Mediclaim Policy | 50,000 – 10 lakh | 92.00% | Affordable plans designed for small sums insured, with coverage for critical illness and pre-existing conditions. |
| HDFC ERGO Mediclaim Policy | 5 lakh – 2 crore | 99.16% | Offers instant coverage, no limits on room rent, global coverage options, and excellent customer support. |
| ManipalCigna Mediclaim Policy | 2.5 lakh – 1 crore | 88.59% | Extensive hospital network plus wellness and preventive health services. |
| Niva Bupa Mediclaim Policy | 5 lakh – 1 crore | 92.02% | Provides family floater coverage with a wide hospital network for cashless treatment. |
| Reliance Mediclaim Policy | 3 lakh – 5 crore | 99.57% | High sum insured options, offer cashless claims and worldwide medical coverage. |
| SBI Mediclaim Policy | 3 lakh – 2 crore | 97.05% | Wide hospital network with a quick claim settlement process for a hassle-free experience. |
| Star Health Mediclaim Policy | 3 lakh – 25 lakh | 82.31% | Plans designed to cover chronic diseases and fast claim settlements, plus free health check-ups. |
| TATA AIG Mediclaim Policy | 5 lakh – 3 crore | 95.43% | Flexible plans with add-ons, including maternity and critical illness coverage, tailored to individual needs. |
Note: The List is arranged in alphabetical order, and the figures are subject to change periodically. The information presented here is for comparison purposes only. Coverfox does not prefer or endorse any particular health insurance company over others. We remain impartial and encourage you to carefully assess all options based on your individual needs before making a decision.
There are two means to file a claim under your Mediclaim Policy in India, which include Cashless Claims and Reimbursement Claims.
Here’s how the process of cashless claims works:
You don’t pay the hospital bills upfront, but the insurance company pays directly, and this is available only at network hospitals partnered with your insurer.
At the hospital, show your health insurance card or policy details at the TPA (Third Party Administrator)/insurance desk.
The hospital sends a request to the insurer for pre-approval, and the insurer reviews the claim based on your policy coverage.
If approved, the hospital bills are paid directly by the insurer, excluding non-covered expenses or co-payments.
For planned treatments, inform your insurer 24-48 hours before admission, and in emergencies, notify your insurer within 24 hours of hospitalisation.
Delayed or incomplete documents can lead to the denial of the cashless facility.
In case your cashless claim was denied or you were treated at a non-network hospital, here’s how to file a reimbursement claim:
You pay the medical bills upfront if you receive treatment at a non-network hospital or if cashless is not approved.
Collect all original bills, medical reports, discharge summaries, prescriptions, and the claim form.
Submit these documents to your insurer for reimbursement.
The insurer checks if the treatment is covered and the documents are complete.
After approval, the insurer transfers the eligible amount to your bank.
Submit your claim within the insurer’s specified time frame (usually within 30 days of discharge) to avoid rejection.
Delayed claims may be considered in special cases, but are not guaranteed.
With our team of dedicated professionals at Coverfox, we help provide you with expert guidance, assisting you with claims every step of the way, be it from the documentation related to filing the claim to the follow-ups required.
Coverfox is an IRDAI-authorised platform that is dedicated to making your journey towards finding the ideal Mediclaim Policy not just instant and seamless, but also transparent. With Coverfox, you can find a policy that is tailored to your needs while enjoying the benefit of expert advice, personalised recommendations and great savings! Along with these, check out the other wide range of benefits that you simply can't miss out on:
Enjoy the convenience of browsing and comparing across a variety of policies from our list of trusted insurance providers, be it premiums, inclusions or exclusions—and pay securely once you land on the policy of your choice.
Renewals are made easy and instant, with a simple 2-step process to follow, so you can enjoy the continued benefits of your chosen policy.
We help provide 24/7 end-to-end support with a dedicated team to assist with any of your queries or doubts regarding the entire claim process.
We are committed to providing our customers with reliable services and smooth assistance through chat, call and email support, making us a trusted platform for lakhs of individuals to consider, while also being rated highly across platforms like Google and Facebook.
According to Section 80D of the Income Tax Act, getting a Mediclaim policy can help individuals save on taxes if they pay premiums for themselves, their spouse, children, and elderly parents, with deductions ranging from ₹25,000 to ₹1,00,000 depending on their age and the premium amount.
You can cover yourself, your spouse, and dependent children under a single policy and claim a tax deduction of up to ₹25,000 per year on the premiums paid. If you also pay premiums for your parents who are under 60, you can claim an additional ₹25,000 deduction. For parents aged 60 or above (senior citizens), the deduction limit rises to ₹50,000. This means if you pay premiums for both your immediate family and senior citizen parents, you can claim up to ₹75,000 in tax deductions in a financial year.
For Indian families, a family floater Mediclaim policy works best, covering multiple members, like policyholders, their spouses, children and maybe even parents, under a single insured sum.
The ideal Mediclaim policy helps cover hospitalisation expenses resulting from any accident, injury or illness, including inpatient care like OT expenses, doctor’s fees, nursing charges, medicine costs, room rent, ICU charges, etc., and these policies may be available on an individual or floater basis.
There are two ways to claim the benefits of a Mediclaim Policy, which are through cashless or reimbursement claims. With cashless claims, the insurer directly settles the bills with its tie-up network of hospitals. However, if a cashless claim gets denied or the policyholder is at a non-network hospital, then reimbursement claims involve the policyholder paying upfront and then submitting bills and documents to get reimbursed accordingly.
Selecting the ideal Mediclaim policy involves having a look at a variety of factors, such as the sum insured, scope of coverage, waiting period for pre-existing conditions, the entry age, checking for sub-limits or co-payments, other policy inclusions and exclusions, and the insurer’s Claim Settlement Ratio (CSR).
Inform your insurer or TPA immediately, and then collect all medical documents, bills, discharge summaries, and prescriptions to submit within a certain period of time to get reimbursed. For cashless claims, you can simply show your health card at the desk.
Yes, most Mediclaim policies do cover hospitalisation expenses incurred due to an accident.
A Mediclaim may offer affordable premiums compared to regular health insurance, but health insurance is known to offer broader coverage with more flexibility.
Compared to regular health insurance, a Mediclaim policy mainly focuses on hospitalisation expenses and may have lower premiums due to this. Health insurance offers broader coverage, including coverage for hospital daily cash, OPD expenses, annual check-ups, alternative treatments, etc., and is more flexible to customise with a higher sum insured.
To avoid policy lapse, timely renewal of mediclaim is a must. You can use Coverfox as a convenient online platform to renew your policy instantly and effectively.
A floater Mediclaim policy is a type of policy which allows multiple family members, including spouse, children and even parents, to enjoy medical benefits under a single sum insured.
An overseas Mediclaim policy may cover any sudden, unforeseen medical emergencies, such as accidental injuries or illnesses, during your travels abroad.
In general, no. Most insurance providers may not include coverage for dental treatments, but you can confirm the details with your insurer before purchasing a policy.
